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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093606935
Report Date: 06/30/2023
Date Signed: 06/30/2023 02:06:16 PM

Document Has Been Signed on 06/30/2023 02:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KINDERCARE LEARNING CENTER - FRANCISCO (INF)FACILITY NUMBER:
093606935
ADMINISTRATOR:STAPLES, ROBBFACILITY TYPE:
830
ADDRESS:2220 FRANCISCO DR.TELEPHONE:
(916) 941-0358
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 14DATE:
06/30/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Robb StaplesTIME COMPLETED:
02:20 PM
NARRATIVE
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On June 30th, 2023 Licensing Program Analysts (LPAs) Soleil Marx and Kyrsten Williams met with Director, Robb Staples, for a case management inspection. There was a census of 14 infants with four staff.

While conducting observations, LPA's observed that three staff were supervising six infants in one classroom. It was confirmed by interview and record review that there was not a fully qualified infant teacher in the classroom, due to the the qualified teacher being on a break.

During record review, a children's file could not be reviewed due to the file being missing from the facility.

Title 22 deficiencies are being cited on 809-D.

The director was informed that this report dated 06/30/2023 documents one Type A citation which shall be posted for 30 consecutive days. The director shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Director has been provided with appeal rights.



Exit interview conducted with Director, report was reviewed, and appeal rights were provided. Director received a Notice of Site which must remain posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 06/30/2023 02:06 PM - It Cannot Be Edited


Created By: Soleil Marx On 06/30/2023 at 01:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KINDERCARE LEARNING CENTER - FRANCISCO (INF)
FACILITY NUMBER: 093606935

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/03/2023
Section Cited
CCR
101416.2(e)

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101416.2 Infant Care Teacher Qualifications and Duties
(e) Under the direction and supervision of the director and assistant director, the infant care teacher shall provide direct care and supervision to infants at the center.
This requirement is not met as evidenced by:
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Director will submit to LPA Marx a break and lunch schedule showing qualified staff in the classroom at all times, by POC due date
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Based on observation, interview, and record review this requirement was not met as there was no qualified infant teacher in the classroom which poses an immediate Health, Safety, or personal Righrs risk to persons in care.
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Type B
07/14/2023
Section Cited
CCR101221(a)

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101221 Child's Records
(a) A separate, complete and current record for each child is maintained in the child care center.

This requirement is not met as evidenced by:
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Director will submit the completed children's file to LPA Marx by POC due date
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Based on record review this requirement was not met as there was a childrens file missing from the facility which poses a potential Health, , Safety, or personal Righrs risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Natalie Dunaway
LICENSING EVALUATOR NAME:Soleil Marx
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2023


LIC809 (FAS) - (06/04)
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